Game on! Supreme Court hears health care reform arguments

The U.S. Supreme Court case everyone has been waiting for is finally here. The High Court began hearing oral arguments on the constitutionality of the landmark Affordable Care Act (ACA) health care reform law on Monday, March 26. An unprecedented six hours of arguments will set the stage for a decision—probably in late June—on whether “Obamacare” stays or goes.

If the court strikes down the ACA, expect the employer-provided health insurance landscape to remain largely as it has for the last 50 years. If the court affirms it, the ACA’s ambitious timetable for revamping the nation’s health insurance system will continue.

The ACA was challenged four times last year in federal appeals courts. Two panels said the law passes constitutional muster. One said it was too soon to decide the question. A fourth ruled parts of the law unconstitutional.

The Supreme Court agreed to hear the government’s appeal of the last case, an August 2011 decision by the 11th Circuit Court of Appeals in Atlanta. That case was originally filed by attorneys general from 26 states.

This week, the Justices are hearing arguments on four questions from the 11th Circuit case:

1. Is it premature for the Supreme Court to even consider the constitutionality of the Affordable Care Act? This was the topic of the first of three days of arguments. Some critics of the law — which requires almost everyone to have health insurance — contend that the penalty for noncompliance amounts to a tax. If the Supreme Court agrees, then it could rule that the ACA’s constitutionality cannot be decided until someone has to pay the tax in 2015. Listen to an audio recording of the oral arguments here.

2. Does Congress have the authority to require individuals to purchase health insurance—the so-called individual mandate? Under the ACA, those who don’t have at least minimal coverage by 2014 would be required to pay a penalty on their 2015 federal income tax returns. The High Court heard arguments on this question Tuesday, March 27. Listen to an audio recording of the oral arguments here.

3. If the Supreme Court decides that the individual mandate is unconstitutional, can the rest of the law stand? The government concedes that many of the ACA’s provisions, such as requiring insurance companies to cover everyone, will not be financially feasible unless everyone actually has insurance. The Supreme Court heard arguments on this question and the next on Wednesday, March 28. Listen to an audio recording of the oral arguments here.

4. Is it unconstitutional for Congress to require states to expand (and pay for) Medicaid health coverage for those too poor to afford it on their own? The ACA requires states to offer Medicaid coverage to individuals and families with incomes equal to or less than 133% of the federal poverty level. Listen to an audio recording of the oral arguments here.